VA Benefits for Spouses: Eligibility and Rehab Coverage

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Published August 6, 2021 

 

The Department of Veterans Affairs (VA) offers a variety of benefits to veterans, ranging from physical and mental healthcare for veterans and their dependents to monthly disability payments. Spouses of veterans may also be able to use VA benefits if they meet certain VA requirements. These added benefits may include substance abuse treatment through the TRICARE program, which provides comprehensive healthcare coverage for people with special needs.1

If a spouse does not qualify for TRICARE, they may be able to qualify for health insurance through the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). CHAMPVA is for current spouses of veterans who have disabilities or for surviving spouses of service members who died in the line of duty. CHAMPVA will share the cost of certain healthcare services and supplies if the spouse qualifies for the program.1 One of those services is mental health, which includes substance misuse. For this type of care, spouses need to contact CHAMPVA for preapproval.2

Table of Contents

What Benefits Do Spouses of Veterans Receive?

The VA serves more than 360,000 beneficiaries and provides VA benefits for spouses through its healthcare programs and other services for family members and dependents. Veteran spouse benefits depend on certain eligibility requirements. While different programs have unique requirements and purposes, most of them reimburse the costs of covered services. More information on each program is provided below: 3, 4

  • Healthcare—Veterans’ spouses may be eligible for healthcare programs through either TRICARE or CHAMPVA.
  • Education and training—The Survivors’ and Dependents’ Education Assistance Program (also called Chapter 35) and the Marine Gunnery Sergeant John David Fry Scholarship program both offer assistance to spouses of veterans.
  • Employment—VA spouse benefits may include free career counseling.
  • Life insurance options, claims, and beneficiary assistance—Spouses can apply for Family Servicemembers’ Group Life Insurance (FSGLI) coverage. They also have access to free financial advice and will-preparation services.

Do Veterans Spouse Benefits Cover Drug and Alcohol Rehab?

There are times when spouses of veterans may need to seek treatment for drug or alcohol abuse at a rehabilitation facility. Such rehabilitation services can be accessed via TRICARE or CHAMPVA.

Regarding drug and alcohol rehab, TRICARE may cover:

  • Inpatient services (emergency and non-emergency).
  • Intensive outpatient programs.
  • Management of withdrawal symptoms (detoxification).
  • Medication-assisted treatment.
  • Mental health therapeutic services.
  • Office-based opioid treatment.
  • Partial hospitalization programs.
  • Residential substance use disorder treatment.

TRICARE does not cover aversion therapy and unproven treatments. 5

If a spouse qualifies for CHAMPVA, they are allowed up to 3 substance use disorder treatment benefit periods in a lifetime.6 Each benefit period begins on the first day of covered treatment. It ends 365 days later, no matter how many services they received during that year. Cost-sharing amounts will depend on the facility; CHAMPVA typically pays at least 75% of the allowed billing amount.

CHAMPVA offers the following types of substance abuse rehabilitation:

  • Outpatient rehabilitation – Limited individual, family, and group therapy sessions.
  • Detoxification – An inpatient service that requires authorization by CHAMPVA, detox is limited to 7 days per admission. It will be approved only if it is performed under general medical supervision.
  • Inpatient and partial hospitalization rehabilitation – Authorization is required. Limited to one inpatient stay during a single benefit period of 21 days.

Can Veteran Spouses Lose Benefits from Drug Use?

Service-related mental health issues aren’t uncommon among veterans. Veterans and their spouses have to deal with the struggles of being in the military, and some of them turn to drugs or alcohol to help them cope.

The VA will not take benefits away from veterans nor from their spouses unless their disability was caused by substance abuse. For the most part, the only other reason a spouse could lose benefits is if they were found to be involved in willful misconduct. If the VA determines that substance abuse is due to willful misconduct, the spouse is not eligible for compensation or pension for any disabilities related to the misconduct. However, the veteran is still eligible to claim compensation or pension for disabilities not related to the misconduct.7

Veterans Spouse Benefits Eligibility

Getting married is considered to be a Qualifying Life Event (QLE), meaning spouses are eligible for VA benefits immediately upon getting married. Spouses must apply for VA coverage within 90 days of the date of marriage. As for health insurance, spouses will qualify for either TRICARE or CHAMPVA.

The spouses of veterans who are covered by TRICARE have many health plans available to them, including:

  • TRICARE Prime.
  • TRICARE Select.
  • US Family Health Plan (in specific U.S. locations).
  • TRICARE For Life (with Medicare Part A & B coverage).
  • TRICARE Select Overseas.

Although a spouse is immediately eligible for TRICARE, there are 2 steps to the enrollment process. 8

  1. Register in the Defense Enrollment Eligibility Reporting System (DEERS) by completing an application for Uniformed Services Identification Card and a DEERS enrollment form. You will be required to provide documentation.
  2. Enroll in one of the TRICARE plans.

Spouses may be eligible for health care through CHAMPVA if they don’t qualify for TRICARE and at least one of the following is true:9

  • They are married to a veteran who’s been rated by the VA as “permanently and totally disabled” for a service-connected disability.
  • They are the surviving spouse of a veteran who died from a VA-rated service-connected disability.
  • They are the surviving spouse of a veteran who was rated “permanently and totally disabled” from a service-connected disability at the time of death.
  • They are the surviving spouse of a veteran who died in the line of duty for reasons other than misconduct.

Spouses of Disabled Veterans

CHAMPVA is the VA’s health care benefit for eligible spouses and children of permanently disabled veterans. To count as a permanent and total disability, a veteran’s disability must be service-connected, rated 100% (based on either the Schedule for Rating Disabilities or TDIU), and considered permanent.10

The spouse of a disabled veteran is eligible for CHAMPVA as long as they remain married to each other. 10

Surviving Spouses

Surviving spouses are those who were married to a veteran at the time of a veteran’s death. They are eligible for the same VA benefits as spouses of living veterans except for the employment benefit. Additionally, they can apply for the following:4

  • Home loan programs and financial counseling: Surviving spouses can apply for VA home loan programs for buying, building, repairing, and refinancing a home. They can also get financial counseling if they’re having difficulties making payments on VA-backed mortgages.
  • Pre-need eligibility determination for burial in a VA national cemetery: To take some of the burden off of their families, spouses can apply to be buried in a VA national cemetery. They can also apply for help financing burial costs and learn about grief counseling options.
  • Survivors pension: Surviving spouses of veterans with wartime service may be eligible for monthly pension benefits.
  • Compensation for surviving spouse and dependents (DIC): Spouses of service members who died in the line of duty or of veterans who died from a service-related injury or illness may be able to receive a tax-free monetary benefit.

Divorced Spouses

Spouses of veterans may still be eligible for certain military benefits after divorce, including the following:

  • Military Retired Pay: The 1982 Uni­formed Ser­vices For­mer Spouse Pro­tec­tion Act (USFSPA) permits the courts to treat military retired pay as marital property. State law determines how it is divided.11
  • Survivor Benefit Plan (SBP): A former spouse can be designated as a Survivor Benefit Plan beneficiary. Veterans benefits for spouses who are divorced are the same as those for current spouses.12 The SBP will terminate if the divorced spouse remarries before the age of 55 unless the second marriage is dissolved through divorce or death.13

Eligibility for health benefits works differently. There are essentially two rules: the 20/20/20 rule and the 20/20/15 rule.14

Under the 20/20/20 rule, former spouses are eligible to continue their medical coverage under TRICARE if:

  • They were married for at least 20 years.
  • The veteran had at least 20 years of service.
  • The marriage and the military service overlapped by at least 20 years.

Under the 20/20/15 rule, if there are only 15 years of overlap between the marriage and military service, the former spouse may receive up to 1 year of TRICARE coverage (unless they remarry).

Spouses who are divorced from veterans and who do not qualify for the 20/20/20 rule or the 20/20/15 rule may qualify for the Continued Health Care Benefit (CHCBP) program. They can apply for this temporary health care coverage program within 60 days after the loss of military benefits due to divorce. Coverage can be retained through the CHCBP program for up to 36 months for veteran divorcees. 15

Can Spouses of Veterans be Seen at the VA?

Both veterans and their spouses can be seen at VA hospitals as long as both are enrolled in a VA health care system such as TRICARE or CHAMPVA.

In some cases, spouses can also see community care providers through CHAMPVA. The spouse should have a CHAMPVA identification card when seeking treatment from a provider.16 Typically, the cost of care will be reimbursed for any up-front payments they’re required to pay. 3

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How to Apply for Veterans’ Spouse Benefits

The process for applying for benefits as the spouse of a veteran depends on the type of program. For substance abuse, the spouse first needs to apply for VA health care. Once enrolled in the VA health care system, they can apply for either TRICARE or CHAMPVA.

To apply for TRICARE:

Make sure you apply within 90 days of marriage or during the annual fall TRICARE Open Season. Note, however, that you can purchase premium-based plans (TRICARE Reserve Select, TRICARE Retired Reserve, TRICARE Young Adult, and the Continued Health Care Benefit Program) any time, even outside of TRICARE Open Season.17 Use Find a TRICARE Plan to discover the steps needed to apply for each plan.

To apply for CHAMPVA:

To apply, submit these required documents:9

  • Application for CHAMPVA Benefits (VA Form 10-10d), and
  • Other Health Insurance Certification (VA Form 10-7959c), and
  • Documents related to your Medicare status, if any.
    • If you qualify for Medicare, submit a copy of your Medicare card.
    • If you’re 65 years old or older and don’t qualify for Medicare, submit Social Security Administration documentation confirming that you don’t qualify for Medicare benefits under anyone’s Social Security number.

Sources

  1. U.S. Department of Veterans Affairs. (2020). Health care for spouses, dependents, and family caregivers.
  2. U.S. Department of Veterans Affairs. (2017). CHAMPVA Guide: Helping you take an active role in your health care.
  3. U.S. Department of Veterans Affairs. (2019). Information for Dependants.
  4. U.S. Department of Veterans Affairs. (2020). VA benefits for spouses, dependents, survivors, and family caregivers.
  5. Tricare.mil. (2018). Covered Services.
  6. U.S. Department of Veterans Affairs. (2017). CHAMPVA Guide.
  7. NOLO. https://www.nolo.com/legal-encyclopedia/when-willful-misconduct-the-military-makes-veteran-ineligible-benefits.html.
  8. Tricare.mil. (2018). FAQs.
  9. U.S. Department of Veterans Affairs. (2020). CHAMPVA Benefits.
  10. Nolo.com. (2021). Benefits for Disabled Veterans’ Spouses and Children.
  11. Congressional Research Service. (2021). Military Benefits for Former Spouses: Legislation and Policy Issues.
  12. Department of Defense. (2021). Former Spouse.
  13. Military Officers Association of America. (2021). What Happens When I Remarry?
  14. Tricare.mil. (2017). Former Spouses.
  15. Tricare.mil. (2019). Continued Health Care Benefit Program.
  16. U.S. Department of Veterans Affairs. (2021). Community Care – CHAMPVA – Information for Providers.
  17. Tricare.mil. (2021). Enroll or Purchase a Plan.